2020 Mental Health Parity Update

After further review of our mental health parity analysis, we are reversing the decision announced in our June 27 Broker Update. We recently discovered that some of our initial data was inaccurate for mental health emergency room benefits for large group fully-insured business. The 2020 benefits will remain the same as the 2019 benefits and are shown here:

Structured options 13-16

Benefit category Cost share
Emergency room Copay, then coinsurance
Inpatient outpatient Deductible and coinsurance
Outpatient (including office services) Deductible and coinsurance

Please note: The 2020 benefits for structured options 9-12 will also be the same as 2019.

Our mental health parity analysis involved reviewing all medical/surgical claims under the plan and the allowed amounts incurred (or expected to be incurred) under the various benefit categories (e.g., deductible, copay and coinsurance). If the total allowed amount in one or more of these benefit categories exceeds two-thirds of the total allowed for the plan, our determination is that “substantially all of the claims” are subject to that benefit and mental health/substance use disorder (MH/SUD) must therefore be covered in the same way as all of the benefits.

We will communicate any small group product changes (BluePride, BlueFlex and BlueFreedom), during our annual small group product training in September. As a reminder, self-funded groups are responsible for complying with all applicable laws including mental health parity.